title: Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery.
abstract: OBJECTIVE
  Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease.
  
  
  METHODS
  Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival.
  
  
  RESULTS
  Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P=0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P=0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P=0.37). Survivors had shorter CPR duration (25 vs 34 min, P=0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P=0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P<0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P=0.008) and renal failure requiring haemodialysis (OR 14.1, P=0.01).
  
  
  CONCLUSIONS
  ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.
authors.affiliation: Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Bahaaldin
authors.initials: B
authors.lastname: Alsoufi
authors.forename: Abid
authors.initials: A
authors.lastname: Awan
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Alexander
authors.initials: A
authors.lastname: Guechef
authors.forename: Zohair
authors.initials: Z
authors.lastname: Al-Halees
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Al-Ahmadi
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Avedis
authors.initials: A
authors.lastname: Kalloghlian
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005112:Extracorporeal Circulation / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000209:etiology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D019344:Lactic Acid
keywords: Cardiac arrest; Congenital heart disease; Extracorporeal life support; Single ventricle